Transsphenoidal microscopic pituitary surgery is an effective way of treating pituitary tumors. However, minimal invasive approach endoscopic transsphenoidal pituitary surgery has become much more prevalent these days. Endoscopic surgery resects the maximum tumour with less complications. As endoscopic surgery is much safer and less invasive as compared to the microscopic transsphenoidal surgery, selection of technology for the treatment of pituitary adenoma is becoming increasingly equivocal. The main aim of this systematic review was to assess the safety of endoscopic and microscopic transsphenoidal pituitary surgery in terms of postoperative complications. Relevant studies between January 1992 and January 2017 were searched in the Cochrane Library electronic databases, EMBASE and MEDLINE, through a systematic literature search. A total of 1,463 patients reviewed (microscopic group=684, endoscopic group=779), the proportion of diabetes insipidus, septal perforation and other complications related to surgery (include lip anesthesia, nasal anesthesia, deviated septum, saddle nose, sinusitis, synechiae, anosmia) in those patients who had endoscopic surgery were significantly lower (p<0.05). No significant difference emerged between the two approaches in the incidence rates of cerebrospinal fluid leak, meningitis, epistaxis or hypopituitarism (p>0.05). These results support the safety of endoscopic transsphenoidal pituitary adenoma surgery.